Parasomniya — the polytypic paroksizmalny states arising during falling asleep, a dream or the near future after awakening. The nightmares and fears, night enuresis, sleepy intoxication, a sleep-walking, sleepy paralyzes connected with a dream dissotsiativny disorders and violations of food behavior, night groans, a bruksizm and much other concern to them. The diagnosis of a parasomniya is established according to a polisomnografiya with video monitoring. Neuropsychological examination, EEG with provocative tests, brain MRT, consultation of the psychiatrist is in addition conducted. In treatment of a parasomniya use psychotherapy, pharmacotherapy, psychological consultation, reflexotherapy, "programmable awakening".
Before a parasomniya considered directly connected with the maintenance of dreams and carried to the field of psychiatry. Lately, in connection with allocation of phases of a dream and a certain progress in studying of their neurochemistry, idea that similar sleep disorders are result of functional disorders of cerebral regulation of a dream became fundamental. Distinguish a phase of bystry (FBS) and a phase of a slow (FMS) dream. Assume that introduction of components of one phase of a dream in another is the cornerstone of a parasomniya. Dependence on phases of a dream is the basis for classification of the parasomniya used in clinical neurology since 2005. According to it allocate disorders of awakening, the parasomniya which are associated with FBS, other parasomniya.
In some cases parasomniya do not break social adaptation of the patient and do not demand therapy. However often they lead to emergence of an insomniya or gipersomniya, can be followed by dangerous behavior in relation to people around and to themselves. Besides, parasomniya can have secondary character and be a symptom of various psychiatric, neurologic and all-somatic diseases.
Disorders of awakening
Nightmares — the episodes of night shout accompanied with the behavioural manifestations corresponding to strong fear. The peak of occurrence is the share at children of age from 4 to 12 years, adults — on the third ten have lives. At children with epilepsy it is observed twice more often than on average in population. During a paroxysm of people suddenly sits down in beds and shouts. His eyes are open, but it . It is noted , tachycardia, , , a muscular hyper tone. The attack comes to an end with transition to a dream or awakening with some disorientation. Its full amnezirovaniye is characteristic. In certain cases the episode of nightmare is followed by aggressive behavior. Polisomnografiya shows emergence of paroxysms in the period of a delta dream, EEG does not reveal Epi categories. Existence in a phase of wakefulness of nonspecific slow bilateral and synchronous activity is typical for people with this type of a parasomniya.
Sleepwalking (sleep-walking, snokhozhdeniye) — the parasomniya which is characterized by the unconscious difficult physical activity occurring in a dream. Meets in 4-12 years more often that connect with immaturity of cerebral regulation of a dream; at adults — incidentally after strong shocks or positive global vital events. During a snokhozhdeniye attack patients can perform simple operations (to feel own clothes, to rub eyes), sitting in a bed, or get up, go, can draw, play the piano, go outside. At the same time they have the "absent" appearance, nekontaktna, do not understand danger and can do harm to others or themselves. It is not always possible to wake the person in the period of a snokhozhdeniye if it works well, then such awakening can provoke at it a fear attack. Episodes of a sleep-walking are observed in the period of a slow dream. Can have a variable EEG-picture: delta activity flashes, monotonous alpha rhythm, low-amplitude bilateral and synchronous theta rhythm.
Sleepy intoxication (awakening with the confused consciousness). This type of a parasomniya is often combined with nightmares, sleepwalking and night enuresis; meets at long and deeply sleeping children more often. Lengthening of time of transition a dream wakefulness is typical. Confusion of consciousness when awakening is shown by block, some temporary and spatial disorientation. The episode of such parasomniya proceeds with the lowered motor activity, but can be followed by avtomatizm, aggressive and/or inadequate behavior. Duration of sleepy intoxication varies from 1-2 min. to an hour. After a while there steps amnesia on the events which were taking place during a parasomniya episode. Polisomnografiya defines the beginning of paroxysms in a phase of a slow dream, EEG - poorly expressed diffusion alpha rhythm or periodic delta activity.
Parasomniya, associated with FBS
Sleepy paralysis — the episode of impossibility of commission of any movements lasting several minutes, at preservation of a normal respiratory excursion of a thorax and glazodvigatelny function. Arises during immersion in a dream or at a prosypaniye. Is followed by feeling of alarm or fear. Periodic attacks of this type of a parasomniya were noted approximately at 5-6% of people, several family cases are described. When carrying out a polisomnografiya specific changes are absent. Parasomniya, associated with FBS, it is necessary to differentiate from a narcolepsy, a katalepsiya, psychogenic paralyzes, atonichesky epipristup, gipokaliyemichesky paralysis, morning local paralysis owing to a sdavleniye of a peripheral nerve during sleep.
Nightmares — difficult and long fantastic dreams, the menacing character. Prevail at children. Can occur against the background of alcoholism, a barbituromaniya, abuse of methylphenidate or amphetamine; at reception of psychostimulators with the medical purposes. The frightening component of nightmares accrues eventually. As a rule, emotional and affective reaction of fear is combined with some vegetative symptoms (gipergidrozy, heartbeat, feeling of shortage of air, etc.). Distinctive features of this type of a parasomniya are: bystry restoration of full clarity of consciousness when awakening and distinct memories of the maintenance of a dreadful dream. Polisomnografiya shows emergence of an attack in the period of a REM sleep that allows to differentiate nightmares from a parasomniya in the form of the nightmares occurring in the period of a slow dream.
The violations of behavior connected with FBS — the difficult physical activity arising in the period of a REM sleep which is closely connected with a dream. Are more often noted at men. Motor phenomena vary from simple (for example, the movements only by one hand) to very difficult motive acts which are followed by a snogovoreniye or shouts; in certain cases remind a snokhozhdeniye. About 60% of this type of a parasomniya make the idiopathic cases which are observed mainly at persons 60 years are more senior. Symptomatic (secondary) episodes of violation of behavior in the period of FBS meet at dementia, chronic ischemia of a brain, subarakhnoidalny hemorrhage, intracerebral tumors, olivo-ponto-tserebellyarnoy degenerations.
Sleepy enuresis — the involuntary urinations occurring in a dream. Parasomniya can be characterized by single episodes of night enuresis in a week or a nightly involuntary urination. Meets mainly at children's age, and with increase in age the frequency of occurrence falls. So, among children of 4 years bed wetting is observed at 30 children from 100, and at the age of 12 years — only at 3. It is connected with gradual maturing of regulatory mechanisms both a dream, and night urination. It is noted that the last has other regulatory mechanisms, than a day urination, and it is closely connected with regulation of a dream. Polisomnografiya reveals developing of sleepy enuresis upon transition from FMS to FBS to which the category of delta waves of high amplitude which is followed by increase of breath and pulse, and also physical activity in a dream precedes. Secondary night enuresis, as a rule, develops several years later after similar episodes of a parasomniya at early children's age. It is a symptom of some urological diseases (cystitis, an uretrit), crescent and cellular anemia, diabetes.
The violation of food behavior connected with a dream — the repeating unconscious episodes of drink of water and meal arising at night awakening. 65-80% of the diseased make women. As a rule, parasomniya with violation of food behavior arise against the background of a long depression; are possible at encephalitis, hepatitis, during refusal of smoking, the termination of the use of drugs or alcohol at dependence existence. Usually episodes of a parasomniya proceed in a condition of incomplete awakening, amnezirutsya partially or completely. During a paroxysm strange combinations of products can be eaten and even toxic agents (for example, means of household chemicals), the patient can be injured by a knife and get burn. Similar parasomniya can lead to anorexia, the increased content of cholesterol in blood, to development of obesity, allergy and problems from bodies of a GIT (gastritis, stomach ulcer, sharp pancreatitis).
The Dissotsiativny frustration connected with a dream — the emotional and behavioural psychogenic reactions happening before withdrawal to a dream or right after transition to wakefulness. Are noted at victims of violence and represent reconstruction of a case of violence. Are followed by avtomatizm and the confused condition of consciousness. Last of minutes till 1 o'clock. Usually amnezirutsya completely.
Night groans — the serial rather loud sounds made by the patient during sleep. The reasons of this parasomniya are not defined yet. Duration of a series can fluctuate from 1 minute to an hour, in a night there can be several such series. Feature is preservation of the quiet look groaning the termination of a series of groans by "low" or a sigh, lack of complaints to frustration of a dream.
Syndrome of "the blowing-up head" - feeling of the loud sharp noise, according to the description of patients reminding "explosion" or "loud blow" which "comes directly from the head". Episodes of a parasomniya arise before falling asleep or during night awakenings. The reasons are not established. It is known that similar paroxysms were observed at healthy people after a severe stress or overfatigue.
Diagnostics of a parasomniya
Diagnostic search at a parasomniya is carried out by joint efforts of the neurologist and somnologist. It is directed both to establishment of the diagnosis, and to detection of secondary character of a parasomniya and the main disease standing behind it. The last has paramount value at adult patients since at them in most cases the parasomniya is secondary.
The polisomnografiya with video monitoring acts as the main diagnostic method. Polisomnografiya allows to allocate dream phases, to analyse their current, to reveal failure in change of phases. During inspection data on bioelectric activity of a brain, a condition of cardiovascular and respiratory systems are registered; the night pulsoksimetriya and a kapnografiya is carried out. Video surveillance allows to monitor emotional and affective reactions and motive phenomena. In respect of a parasomniya difdiagnostika with epilepsy in addition can day EEG-monitoring and EEG with provocative tests by results of which consultation of an epileptolog is appointed is carried out.
At diagnostics of a parasomniya at adults for an exception of cerebral organic pathology also transkranialny UZDG is recommended to KT or MPT of a brain, UZDG of ekstrakranialny vessels. Assessment of psycho-emotional features of the patient is carried out by psychological testing, a research of structure of the personality, neuropsychological inspection. At suspicion about emergence of a parasomniya against the background of a mental disorder consultation of the psychiatrist is appointed.
Treatment of a parasomniya
In cases when the parasomniya does not bear negative impact on everyday life of the patient, she does not demand treatment. In other cases depending on the prime cause and features of a parasomniya, existence of a background disease its therapy is performed by the neurologist, the psychologist, the psychiatrist or their joint efforts.
Important value has creation of correct "ritual" of falling asleep and respect for hygiene of a dream. At children practice so-called "programmable awakening" - in 15-20 min. prior to time when usually there is an episode of a parasomniya, awake the child, and then again put to bed. At night enuresis of patients specially awake that they descended in a toilet. If episodes of a parasomniya are connected with active motive acts, then take measures to secure the patient during sleep. For example, remove sharp and fragile objects from the room, close windows.
Among non-drug methods of treatment by the main psychological consultation, cognitive and behavioural psychotherapy, psychoanalysis, psychoanalytic psychotherapy are. The reflexotherapy, an electrodream, medical phytobathtubs with sedative collecting is applied. In parasomniya pharmacotherapy the leading place is allocated to the medicines with GAMK-ergichesky effect i.e. exponentiating brake influence of GAMK in TsNS. Benzodiazepines concern to them: clonazepam, lorazepam, diazepam, to gidazepa and so forth. According to indications use of sedatives (a valerian root, a motherwort, tincture of a peony and the combined phytomedicines), antidepressants () and anksiolitik is possible (, , ). In complex therapy of a parasomniya at children use the nootropic medicines allowing to accelerate maturing of mechanisms of regulation of a dream.